title: Hemostasis alterations in patients with acute aortic dissection.
abstract: BACKGROUND
  Surgery for acute aortic dissection (AAD) is frequently complicated by excessive postoperative bleeding and blood product transfusion. Blood flow through the nonendothelialized false lumen is a potential trigger for the activation of the hemostatic system; however, the physiopathology of the aortic dissection induced coagulopathy has never been precisely studied. The aim of the present study is the evaluation of the coagulation and fibrinolytic systems and platelet activation in patients undergoing surgery for AAD.
  
  
  METHODS
  Eighteen patients undergoing emergent surgery for Stanford type A AAD were enrolled in the study. The activation of the coagulation and fibrinolytic systems and platelet activation were evaluated at 6 different time points before, during, and after the operation, measuring prothrombin fragment 1.2 (F1.2), plasmin-antiplasmin complex, and platelet factor 4, respectively.
  
  
  RESULTS
  All measured biomarkers were increased before, during, and after the operations indicating a systemic activation of coagulation, fibrinolysis, and platelets. These changes were pronounced even preoperatively (T0), and soon after the beginning of cardiopulmonary bypass (T1) when the influence of hypothermia and prolonged cardiopulmonary bypass time were not yet involved. Time from symptom onset to intervention inversely correlated with preoperative F1.2 (r=-0.75; p=0.002) and plasmin-antiplasmin levels (r=-0.57; p=0.034).
  
  
  CONCLUSIONS
  Blood flow through the false lumen is a powerful activator of the hemostatic system even before the operation. This remarkable activation may influence postoperative outcome of AAD patients.
authors.affiliation: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy. dpaparella@cardiochir.uniba.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
authors.forename: Crescenzia
authors.initials: C
authors.lastname: Rotunno
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Malvindi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scrascia
authors.forename: Micaela
authors.initials: M
authors.lastname: De Palo
authors.forename: Emanuela
authors.initials: E
authors.lastname: de Cillis
authors.forename: Alessandro S
authors.initials: AS
authors.lastname: Bortone
authors.forename: Luigi
authors.initials: L
authors.lastname: de Luca Tupputi Schinosa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000503:physiopathology; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome